High Prevalence of Hip Dysplasia in Patients with Scoliosis: A Retrospective Study

High Prevalence of Hip Dysplasia in Patients with Scoliosis: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article High Prevalence of Hip Dysplasia in Patients with Scoliosis: A Retrospective Study Zhou Anli, Lu Ning, Wang Yingsong, Zhao Zhi, Li Tao, Tang Hao, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6088301/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract [Objectives] : There is a complex biomechanical relationship between the spine and hip joints, but the prevalence and clinical significance of developmental dysplasia of the hip (DDH) in patients with scoliosis have not been thoroughly investigated. This study aimed to assess the prevalence of DDH in patients with scoliosis and analyze their associations with different types of scoliosis. [ Methods] : A total of 331 patients with scoliosis (average age of 16.3 years; 73% female) were included in the study. Preoperative full-length spinal radiographs were used to measure the Cobb angle, lateral center-edge angle (LCEA) and Tönnis angle. Single-sample z tests were conducted to analyze the prevalence of DDH, and the results were compared with those of the general population. [ Results] : The overall prevalence of DDH was 27.5%, significantly higher than in the general population (1.52%). By subtype, the prevalence was 21% for idiopathic scoliosis, 39.6% for congenital scoliosis, 29.5% for neuromuscular scoliosis, and 30% for degenerative scoliosis. Among patients, 12.4% had bilateral dysplasia. [ Conclusions] : The prevalence of DDH is significantly greater in patients with scoliosis. This finding highlights the importance of systematically evaluating hip development in scoliosis patients to facilitate early intervention and improve outcomes. Scoliosis Developmental dysplasia of the hip High prevalence of hip dysplasia Figures Figure 1 Figure 2 Introduction Developmental dysplasia of the hip (DDH) encompasses various deformities affecting the developing hip joint, such as complete dislocation, subluxation, joint instability, and dysplasia of the femoral head and acetabulum [1]. When left untreated, DDH can lead to significant joint pain and functional impairment [2]. Early detection and treatment can result in good outcomes for the majority of cases. However, undiagnosed and untreated hip dislocations and subluxations may result in early degenerative changes in the hip joint. Previous studies reported a DDH incidence of 1.40% newborns [3]. The overall incidence of DDH in China is approximately 1.52%, with about 0.75% in males and approximately 2.07% in females [4]. Scoliosis is a complex three-dimensional spinal deformity. The Scoliosis Research Society (SRS) defines it as a Cobb angle of ≥10° measured on standing full-spine coronal X-rays [5,6]. According to its etiology, scoliosis can be categorized as idiopathic, congenital, neuromuscular, neurofibromatosis-associated, and degenerative scoliosis [7]. Previous studies have shown that patients with adolescent idiopathic scoliosis (AIS) and early-onset scoliosis (EOS) have a greater risk of developing DDH than does the general population [8,9,10,11]. However, most previous research has focused on AIS and EOS patients, with limited data on the prevalence of DDH in patients with other types of scoliosis. This study aimed to determine the prevalence of DDH in patients with various types of scoliosis across different age groups in China. Methods A retrospective analysis of the medical records and radiographs of scoliosis patients who were diagnosed and treated at the Second Affiliated Hospital of Kunming Medical University between September 2017 and September 2023 was conducted. The inclusion criteria were as follows: (1) confirmed scoliosis diagnosis with a Cobb angle ≥ 10° (measured from standing full-spine radiographs); and (2) complete preoperative standing full-spine radiographs enabling accurate measurements of parameters such as the Cobb angle, LCEA (Lateral Center-Edge Angle), and Tönnis angle. Patients also needed to have complete electronic medical records to ensure the accuracy and consistency of the study data. The exclusion criteria were as follows: (1) a history of previous spinal or hip surgery; (2) poor-quality or missing imaging data or difficulties in conducting measurements due to conditions such as severe osteoporosis, hip infection, or tumor; and (3) systemic diseases known to affect hip development (e.g., rheumatoid arthritis or systemic lupus erythematosus). Imaging Parameter Measurements : The following coronal plane parameters of the spine and hip joints were measured: (1) Cobb angle; (2) (lateral center-edge angle (LCEA); and (3) Tönnis angle. The detailed measurement methods are shown in Fig. 1 . DDH was diagnosed when LCEA 10° [ 13 ]. To increase the sensitivity of the study, any patient with abnormal values for any one of these parameters was classified as having DDH. Statistical Analysis For quantitative data, values are expressed as mean ± standard deviation. To assess whether the prevalence of DDH in patients with different types of scoliosis is significantly higher than the known prevalence in the general population (1.52%) [ 4 ], we conducted a one-sample proportion z-test and calculated the 95% confidence interval (CI). A p-value of less than 0.05 was considered statistically significant in all statistical tests. Results A total of 331 scoliosis patients (662 hips) were included in this study from September 2017 to September 2023. The age range of the patients was 2 to 63 years, and 73% were female. The characteristics of the patients are listed in Table 1 . Patients were grouped according to the etiology of scoliosis, including idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis and degenerative scoliosis. Table 1 Patient Characteristics Characteristics Value Total hip joints 662 Total Patients 331 Sex Female 241 Male 90 Age 16.3 ± 9.2 BMI 18.8 ± 3.9 Cobb angle 51.2 ± 21.7° LECA Left 33.0 ± 8.7° Right 33.5 ± 8.9° Tönnis Left 7.1 ± 5.1° Right 7.2 ± 5.0° BMI:Body Mass Index. LCEA: Lateral center-edge angle The overall DDH prevalence among 331 patients was 27.5% (95% CI: 22.7–32.3%; p < 0.05), significantly higher than in the general population. Forty-one patients (12.4%) had bilateral dysplasia (Table 2 ). There were significant differences in the prevalence of DDH among patients with different types of scoliosis (Fig. 2 ), Notably, EOS is a specific type of scoliosis, defined as scoliosis with an onset before the age of 10 [ 14 ]. Among the 331 patients, there were 31 cases of Early-Onset Scoliosis, including 20 cases associated with dysplasia (64.5%). Table 2 Hip Joint Results Variables N (%) Z value Developmental dysplasia 91 (27.5) 38.6 Bilateral 41 (12.4) Left 26 (7.9) Right 24 (7.2) Discussion This study systematically evaluated the prevalence of DDH in patients with different types of scoliosis and reported that the overall prevalence of DDH was significantly greater than that in the general population. Previous studies have reported that the prevalence of DDH in the general population was 1.40% [ 3 ]. In our sample, the prevalence of DDH reached 27.5%, which is 20 times higher than that of the general population. This significant increase may be attributed to scoliosis, which can cause uneven load distribution in the hip joint [ 8 , 9 , 15 ]. Although previous studies have reported that left-sided DDH is more common [ 16 , 17 ], our study revealed that no significant difference, This discrepancy may be influenced by variations in ethnicity, scoliosis subtypes, or methodological differences in the studies. The literature has reported that female sex is a known risk factor for DDH [ 18 ]. This finding was further validated in our study, where 73% of the patients were female, indicating that sex may contribute to the high prevalence of DDH in scoliosis patients. Overall, the high prevalence of DDH and the difference in the side distribution found in this study highlight the importance of systematic hip evaluations in scoliosis patients. Our conclusions differ from those of previous studies (Table 3 ). In our study, the prevalence of DDH in scoliosis patients was as high as 27.5%. The higher prevalence observed in our study may be attributed to differences in study design and patient population. Unlike earlier studies that primarily focused on AIS, our study included a broader range of scoliosis subtypes, such as congenital, neuromuscular, and degenerative scoliosis, where DDH risk may be inherently higher. Additionally, we employed more inclusive diagnostic criteria, combining the LCEA and Tönnis angle, which likely increased the sensitivity of DDH detection. Variations in ethnicity, age distribution, and sample size might also have contributed to these differences. Future research should aim to standardize diagnostic parameters and include diverse populations to further validate these findings and ensure broader applicability。 Table 3 Comparison of DDH prevalence in Scoliosis patients in this study and previously Scoliosis type DDH prevalence (%) Sample Size Location Hooper et al. 1980 [ 19 ] Idiopathic 6.4 156 UK Segreto et al. 2018 [ 9 ] Idiopathic 1.4 1073 USA Early-onset 3.9 1005 USA Talmage et al. 2020 [ 10 ] Early-onset 11.1 81 USA Bortz et al. 2022 [ 8 ] Idiopathic 0.41 24656 USA Zhao et al. 2023 [ 20 ] Idiopathic 35 103 China Taylor et al. 2023 [ 11 ] Idiopathic 19 200 USA This Study Idiopathic 21 186 China Congenital 39.6 91 Neuromuscular 29.5 44 Degenerative 30 10 Early-Onset 64.5 31 Hip dysplasia can lead to chronic pain, instability, dysfunction, and progressive osteoarthritis [ 21 , 22 , 23 ]. Although X-ray examination is an effective method for detecting DDH, many patients do not receive appropriate screening before symptoms become apparent. Due to a range of compensatory mechanisms, many abnormal forces may take years to cause enough structural damage to produce symptoms and instability [ 15 , 24 ]. Patients are often diagnosed after experiencing pain caused by arthritis progression, missing the optimal window for treatment. Early and timely diagnosis and treatment are highly beneficial. Since the femoral head and the acetabulum both have the ability to grow and remodel, concentric reduction allows the pathological changes of DDH to gradually improve over time. [ 25 ]. Early intervention methods include non-surgical treatments like the use of a Pavlik harness, bracing, or physical therapy to ensure proper hip alignment and enhance joint stability. For severe cases or those identified later, early surgical options like closed reduction or osteotomy may be necessary. This study has several limitations. First, all angle measurements were based on full-length spinal radiographs, which are typically spliced from multiple images, potentially introducing parallax errors. Variations in hip angle measurements due to differing Cobb angles and imaging modalities may also affect accuracy. Second, as most assessments were performed by the authors, measurement errors cannot be ruled out. Future studies should consider incorporating advanced imaging techniques to minimize measurement errors and improve diagnostic precision. Third, although various scoliosis types were included, other factors beyond scoliosis may have contributed to hip dysplasia. Additionally, confounders such as age, sex, and scoliosis type, which might independently influence DDH prevalence, were not adjusted for due to the retrospective design and limited sample size. Future studies should consider stratified or multivariate analyses to address these factors. Finally, the single-center design and demographic homogeneity of our sample, predominantly representing a specific ethnic and geographic population, may limit generalizability. Multicenter studies with more diverse populations are needed to validate and expand our findings for broader clinical applicability. Conclusion This study revealed that the prevalence of DDH in scoliosis patients is significantly greater than that in the general population, reaching 27.5%, the findings emphasize the importance of screening and managing DDH in scoliosis patients. Additionally, the high prevalence of DDH supports the inclusion of comprehensive hip evaluations in scoliosis assessments. Future research should explore the specific pathological mechanisms underlying the association between DDH and scoliosis and assess the effectiveness of different treatment strategies for patients with both conditions. This will provide more precise guidance for clinical treatment planning. Declarations Ethics approval and consent to participate This study was a retrospective study, and all the data were derived from de-identified past medical records; thus, informed consent was not needed. The research protocol was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Kunming Medical University, and a waiver of informed consent was granted (approval number: [FEY-BG-39-3.0]). All procedures performed on this study were in accordance with the ethical standards of the 1964 Helsinki declaration. Funding This study was supported by the External Cooperation Research Project of the Second Affiliated Hospital of Kunming Medical University, Yunnan Province, China (Grant No. 2022dwhz19) and the Academician Liu Bo Workstation of Yunnan Province (Grant No. 202205AF150009). Author Contribution Zhou Anli and Lu Ning wrote the main manuscript text. Zhao Zhi, Li Tao, and Wang Yingsong provided the patient data materials. Cheng Jia, Sun Zhihang, and Shen Xinhe collected the data. Tang Hao and Li Wenjin performed the data analysis. All authors reviewed and approved the final version of the manuscript. References Kotlarsky P, Haber R, Bialik V, Eidelman M (2015) Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 6(11):886–901 Published 2015 Dec 18. 10.5312/wjo.v6.i11.886 Maldonado DR, Aboulafia A, Doddridge J et al (2024) Favorable Early Outcomes and High Clinical Benefit Achievement Rate With Concomitant Hip Arthroscopy and Periacetabular Osteotomy for the Treatment of Developmental Dysplasia of the Hip. Arthroscopy. 10.1016/j.arthro.2024.11.064 Tao Z, Wang J, Li Y et al (2023) Prevalence of developmental dysplasia of the hip (DDH) in infants: a systematic review and meta-analysis. BMJ Paediatr Open 7. 10.1136/bmjpo-2023-002080 . BMJ Paediatr Open Tian FD, Zhao DW, Wang W et al (2017) Prevalence of Developmental Dysplasia of the Hip in Chinese Adults: A Cross-sectional Survey. Chin Med J (Engl) 130(11):1261–1268. 10.4103/0366-6999.206357 Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA (2008) Adolescent idiopathic scoliosis. Lancet 371(9623):1527–1537. 10.1016/S0140-6736(08)60658-3 Altaf F, Gibson A, Dannawi Z, Noordeen H (2013) Adolescent idiopathic scoliosis. BMJ 346:f2508 Published 2013 Apr 30. 10.1136/bmj.f2508 Qiu Y, Zhu F, Wang B et al (2009) Clinical etiological classification of scoliosis: report of 1289 cases. ORTHOP SURG 1(1):12–16. 10.1111/j.1757-7861.2008.00003.x Bortz C, Williamson TK, Adenwalla A et al (2022) The Prevalence of Hip Pathologies in Adolescent Idiopathic Scoliosis. J Orthop 31:29–32 Published 2022 Mar 10. 10.1016/j.jor.2022.02.017 Segreto FA, Vasquez-Montes D, Brown AE et al (2018) Incidence, trends, and associated risks of developmental hip dysplasia in patients with Early Onset and Adolescent Idiopathic Scoliosis. J Orthop 15(3):874–877 Published 2018 Aug 15. 10.1016/j.jor.2018.08.015 Talmage MS, Nielson AN, Heflin JA, D'Astous JL, Fedorak GT (2020) Prevalence of Hip Dysplasia and Associated Conditions in Children Treated for Idiopathic Early-onset Scoliosis-Don't Just Look at the Spine. J Pediatr Orthop 40(1):e49–e52. 10.1097/BPO.0000000000001390 Taylor TN, Bridges CS, Duruewuru AT et al (2023) How Often Do Patients Presenting With Severe Adolescent Idiopathic Scoliosis Have Underlying Hip Dysplasia? J Pediatr Orthop 43(10):e798–e803. 10.1097/BPO.0000000000002513 Wiberg G (1940) Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complication of osteo-arthritis. JAMA 115(1):81 Clohisy JC, Carlisle JC, Beaulé PE et al (2008) A systematic approach to the plain radiographic evaluation of the young adult hip. J BONE JOINT SURG AM 90(Suppl 4):47–66. 10.2106/JBJS.H.00756 Williams BA, Matsumoto H, McCalla DJ et al (2014) Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J BONE JOINT SURG AM 96(16):1359–1367. 10.2106/JBJS.M.00253 Nielsen E, Goldstein RY (2018) Adolescent spine patients have an increased incidence of acetabular overcoverage. J Hip Preserv Surg 5(2):131–136 Published 2018 Mar 9. 10.1093/jhps/hny004 Omeroğlu H, Koparal S (2001) The role of clinical examination and risk factors in the diagnosis of developmental dysplasia of the hip: a prospective study in 188 referred young infants. Arch Orthop Trauma Surg 121(1–2):7–11. 10.1007/s004020000186 Wynne-Davies R, Littlejohn A, Gormley J (1982) Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). J Med Genet 19(5):321–328. 10.1136/jmg.19.5.321 Westberry DE, Davids JR, Pugh LI (2003) Clubfoot and developmental dysplasia of the hip: value of screening hip radiographs in children with clubfoot. J Pediatr Orthop 23(4):503–507 Hooper G (1980) Congenital dislocation of the hip in infantile idiopathic scoliosis. J Bone Joint Surg Br 62–B(4):447–449. 10.1302/0301-620X.62B4.7430221 Zhao X, Pan A, Hai Y (2023) Greater pelvic obliquity in adolescent idiopathic scoliosis combined with hip dysplasia. EUR SPINE J 33(2):680–686. 10.1007/s00586-023-08055-y Kołodziejczyk K, Czubak-Wrzosek M, Kwiatkowska M, Czubak J (2022) Hip dysplasia in adolescence: osteotomy in childhood improves the results of periacetabular osteotomy in adolescents and young adults: a prospective study. Bone Joint J 104–B(7):775–780. 10.1302/0301-620X.104B7.BJJ-2021-1771.R1 LaPrade MD, Melugin HP, Hale RF et al (2021) Incidence of Hip Dysplasia Diagnosis in Young Patients With Hip Pain: A Geographic Population Cohort Analysis. Orthop J Sports Med. ;9(3):2325967121989087. Published 2021 Mar 5. 10.1177/2325967121989087 Schmitz MR, Murtha AS, Clohisy JC, ANCHOR Study Group (2020) Developmental Dysplasia of the Hip in Adolescents and Young Adults. J Am Acad Orthop Surg 28(3):91–101. 10.5435/JAAOS-D-18-00533 Pun S (2016) Hip dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia. Curr Rev Musculoskelet Med 9(4):427–434. 10.1007/s12178-016-9369-0 Lindstrom JR, Ponseti IV, Wenger DR (1979) Acetabular development after reduction in congenital dislocation of the hip. J Bone Joint Surg Am 61(1):112–118 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6088301","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":422939821,"identity":"d7340fbb-6db4-40ff-9d7d-0d53ac90a9bd","order_by":0,"name":"Zhou Anli","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zhou","middleName":"","lastName":"Anli","suffix":""},{"id":422939822,"identity":"26c98b4e-5fd9-4fba-bf2e-b838b063a084","order_by":1,"name":"Lu Ning","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACPiA+AGKwsTcfOPDhBxFa2OBaeI4lHpzZQ6QWCJDIMT7MwYZHKVyLRO7BwwW/DsvxMeR8OMzAwyDPL3aAkJa8hMMz+w4bszGc3XC4wILBcObsBEJacgwO8/bcTmxj7N1weAYPQ4LBbSK11Lcx8zw4zMNGrBaeH7cT2Nh4GIjUwvMGaEvDf8M2HjYDYCBLEPYLP3uO8WeeP2ny8vMfP/7w4YeNPL80AS1gwNgGZ0oQoRwM/hCrcBSMglEwCkYkAACcoUPbxZTLbQAAAABJRU5ErkJggg==","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":true,"prefix":"","firstName":"Lu","middleName":"","lastName":"Ning","suffix":""},{"id":422939823,"identity":"fe9d2c6f-62bf-43bf-9a4c-d044cd8d9f2a","order_by":2,"name":"Wang Yingsong","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Yingsong","suffix":""},{"id":422939824,"identity":"b06bb693-aafe-48e0-b32a-811912ab2083","order_by":3,"name":"Zhao Zhi","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zhao","middleName":"","lastName":"Zhi","suffix":""},{"id":422939825,"identity":"3ba11b5e-122a-470f-b9aa-8a763f53dc1e","order_by":4,"name":"Li Tao","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Tao","suffix":""},{"id":422939826,"identity":"77cc6329-e27d-4c15-b7e7-c6e16aa2401e","order_by":5,"name":"Tang Hao","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Tang","middleName":"","lastName":"Hao","suffix":""},{"id":422939827,"identity":"5c5a5fe0-4187-4946-a9b8-c6cb8b03d3fa","order_by":6,"name":"Li Wenjin","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Wenjin","suffix":""},{"id":422939828,"identity":"244bdd5f-fb83-4cc5-b290-1b7dab0ef055","order_by":7,"name":"Sun Zhihang","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Sun","middleName":"","lastName":"Zhihang","suffix":""},{"id":422939829,"identity":"d8252bbd-969c-4f1e-960d-cdd9415ba66e","order_by":8,"name":"Cheng Jia","email":"","orcid":"","institution":"Second Affiliated Hospital of Kunming Medical College","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Jia","suffix":""},{"id":422939830,"identity":"cd77d696-9acb-46e7-a0a5-4a1686116654","order_by":9,"name":"Shen Xinhe","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shen","middleName":"","lastName":"Xinhe","suffix":""}],"badges":[],"createdAt":"2025-02-23 05:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6088301/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6088301/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77716991,"identity":"85683ba0-3b9f-4928-8254-cb6f8bf7c154","added_by":"auto","created_at":"2025-03-04 14:30:16","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":192418,"visible":true,"origin":"","legend":"\u003cp\u003eStanding full-spine radiograph; \u003cstrong\u003eCobb angle\u003c/strong\u003e: the angle formed by the perpendicular lines drawn from the upper endplate of the upper vertebra and the lower endplate of the lower vertebra; \u003cstrong\u003eLateral center-edge angle (LCEA)\u003c/strong\u003e: the angle between a vertical line through the center of the femoral head and a line from the center of the femoral head to the most lateral point of the acetabulum; \u003cstrong\u003eTönnis angle\u003c/strong\u003e: the angle between a horizontal line and a line connecting the most lateral point of the acetabulum and the most medial point of the sclerotic zone.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6088301/v1/f007dbaf053eadaf85223657.jpeg"},{"id":77717107,"identity":"0daa73c2-9464-4c23-a90e-a0de4faa33bc","added_by":"auto","created_at":"2025-03-04 14:38:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22663,"visible":true,"origin":"","legend":"\u003cp\u003eTotal Patients and Patients with DDH by Scoliosis Type\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6088301/v1/7b03dceb3c07bd962c6deb4a.png"},{"id":79493309,"identity":"7bcf3012-53e5-44a7-b756-e569ccc90378","added_by":"auto","created_at":"2025-03-29 13:23:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":745404,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6088301/v1/8a27daca-89ac-441f-afc7-69e3e15ea432.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High Prevalence of Hip Dysplasia in Patients with Scoliosis: A Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDevelopmental dysplasia of the hip (DDH) encompasses various deformities affecting the developing hip joint, such as complete dislocation, subluxation, joint instability, and dysplasia of the femoral head and acetabulum [1]. When left untreated, DDH can lead to significant joint pain and functional impairment [2]. Early detection and treatment can result in good outcomes for the majority of cases. However, undiagnosed and untreated hip dislocations and subluxations may result in early degenerative changes in the hip joint. Previous studies reported a DDH incidence of 1.40% newborns\u0026nbsp;[3].\u0026nbsp;The overall incidence of DDH in China is approximately 1.52%, with about 0.75% in males and approximately 2.07% in females\u0026nbsp;[4].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScoliosis is a complex three-dimensional spinal deformity. The Scoliosis Research Society (SRS) defines it as a Cobb angle of \u0026ge;10\u0026deg; measured on standing full-spine coronal X-rays\u0026nbsp;[5,6]. According to its etiology, scoliosis can be categorized as idiopathic, congenital, neuromuscular, neurofibromatosis-associated, and degenerative scoliosis\u0026nbsp;[7].\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that patients with adolescent idiopathic scoliosis (AIS) and early-onset scoliosis (EOS) have a greater risk of developing DDH than does the general population [8,9,10,11]. However, most previous research has focused on AIS and EOS patients, with limited data on the prevalence of DDH in patients with other types of scoliosis. This study aimed to determine the prevalence of DDH in patients with various types of scoliosis across different age groups in China.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective analysis of the medical records and radiographs of scoliosis patients who were diagnosed and treated at the Second Affiliated Hospital of Kunming Medical University between September 2017 and September 2023 was conducted.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) confirmed scoliosis diagnosis with a Cobb angle\u0026thinsp;\u0026ge;\u0026thinsp;10\u0026deg; (measured from standing full-spine radiographs); and (2) complete preoperative standing full-spine radiographs enabling accurate measurements of parameters such as the Cobb angle, LCEA (Lateral Center-Edge Angle), and T\u0026ouml;nnis angle. Patients also needed to have complete electronic medical records to ensure the accuracy and consistency of the study data.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: (1) a history of previous spinal or hip surgery; (2) poor-quality or missing imaging data or difficulties in conducting measurements due to conditions such as severe osteoporosis, hip infection, or tumor; and (3) systemic diseases known to affect hip development (e.g., rheumatoid arthritis or systemic lupus erythematosus).\u003c/p\u003e \u003cp\u003e \u003cb\u003eImaging Parameter Measurements\u003c/b\u003e: The following coronal plane parameters of the spine and hip joints were measured: (1) Cobb angle; (2) (lateral center-edge angle (LCEA); and (3) T\u0026ouml;nnis angle. The detailed measurement methods are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. DDH was diagnosed when LCEA\u0026thinsp;\u0026lt;\u0026thinsp;20\u0026deg; [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] or T\u0026ouml;nnis angle\u0026thinsp;\u0026gt;\u0026thinsp;10\u0026deg; [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. To increase the sensitivity of the study, any patient with abnormal values for any one of these parameters was classified as having DDH.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eFor quantitative data, values are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. To assess whether the prevalence of DDH in patients with different types of scoliosis is significantly higher than the known prevalence in the general population (1.52%) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], we conducted a one-sample proportion z-test and calculated the 95% confidence interval (CI). A p-value of less than 0.05 was considered statistically significant in all statistical tests.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 331 scoliosis patients (662 hips) were included in this study from September 2017 to September 2023. The age range of the patients was 2 to 63 years, and 73% were female. The characteristics of the patients are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Patients were grouped according to the etiology of scoliosis, including idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis and degenerative scoliosis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal hip joints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCobb angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.7\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLECA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u0026ouml;nnis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u0026deg;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003eBMI:Body Mass Index. LCEA: Lateral center-edge angle\u003c/p\u003e \u003cp\u003eThe overall DDH prevalence among 331 patients was 27.5% (95% CI: 22.7\u0026ndash;32.3%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), significantly higher than in the general population. Forty-one patients (12.4%) had bilateral dysplasia (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There were significant differences in the prevalence of DDH among patients with different types of scoliosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), Notably, EOS is a specific type of scoliosis, defined as scoliosis with an onset before the age of 10 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Among the 331 patients, there were 31 cases of Early-Onset Scoliosis, including 20 cases associated with dysplasia (64.5%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHip Joint Results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZ value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevelopmental dysplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study systematically evaluated the prevalence of DDH in patients with different types of scoliosis and reported that the overall prevalence of DDH was significantly greater than that in the general population. Previous studies have reported that the prevalence of DDH in the general population was 1.40% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In our sample, the prevalence of DDH reached 27.5%, which is 20 times higher than that of the general population. This significant increase may be attributed to scoliosis, which can cause uneven load distribution in the hip joint [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although previous studies have reported that left-sided DDH is more common [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], our study revealed that no significant difference, This discrepancy may be influenced by variations in ethnicity, scoliosis subtypes, or methodological differences in the studies. The literature has reported that female sex is a known risk factor for DDH [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This finding was further validated in our study, where 73% of the patients were female, indicating that sex may contribute to the high prevalence of DDH in scoliosis patients. Overall, the high prevalence of DDH and the difference in the side distribution found in this study highlight the importance of systematic hip evaluations in scoliosis patients.\u003c/p\u003e \u003cp\u003eOur conclusions differ from those of previous studies (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In our study, the prevalence of DDH in scoliosis patients was as high as 27.5%. The higher prevalence observed in our study may be attributed to differences in study design and patient population. Unlike earlier studies that primarily focused on AIS, our study included a broader range of scoliosis subtypes, such as congenital, neuromuscular, and degenerative scoliosis, where DDH risk may be inherently higher. Additionally, we employed more inclusive diagnostic criteria, combining the LCEA and T\u0026ouml;nnis angle, which likely increased the sensitivity of DDH detection. Variations in ethnicity, age distribution, and sample size might also have contributed to these differences. Future research should aim to standardize diagnostic parameters and include diverse populations to further validate these findings and ensure broader applicability。\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of DDH prevalence in Scoliosis patients in this study and previously\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScoliosis type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDDH prevalence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHooper et al. 1980 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSegreto et al. 2018 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly-onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTalmage et al. 2020 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly-onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBortz et al. 2022 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhao et al. 2023 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e 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\u003cp\u003eThis Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongenital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuromuscular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegenerative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly-Onset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e64.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHip dysplasia can lead to chronic pain, instability, dysfunction, and progressive osteoarthritis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Although X-ray examination is an effective method for detecting DDH, many patients do not receive appropriate screening before symptoms become apparent. Due to a range of compensatory mechanisms, many abnormal forces may take years to cause enough structural damage to produce symptoms and instability [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Patients are often diagnosed after experiencing pain caused by arthritis progression, missing the optimal window for treatment. Early and timely diagnosis and treatment are highly beneficial. Since the femoral head and the acetabulum both have the ability to grow and remodel, concentric reduction allows the pathological changes of DDH to gradually improve over time. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Early intervention methods include non-surgical treatments like the use of a Pavlik harness, bracing, or physical therapy to ensure proper hip alignment and enhance joint stability. For severe cases or those identified later, early surgical options like closed reduction or osteotomy may be necessary.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, all angle measurements were based on full-length spinal radiographs, which are typically spliced from multiple images, potentially introducing parallax errors. Variations in hip angle measurements due to differing Cobb angles and imaging modalities may also affect accuracy. Second, as most assessments were performed by the authors, measurement errors cannot be ruled out. Future studies should consider incorporating advanced imaging techniques to minimize measurement errors and improve diagnostic precision. Third, although various scoliosis types were included, other factors beyond scoliosis may have contributed to hip dysplasia. Additionally, confounders such as age, sex, and scoliosis type, which might independently influence DDH prevalence, were not adjusted for due to the retrospective design and limited sample size. Future studies should consider stratified or multivariate analyses to address these factors. Finally, the single-center design and demographic homogeneity of our sample, predominantly representing a specific ethnic and geographic population, may limit generalizability. Multicenter studies with more diverse populations are needed to validate and expand our findings for broader clinical applicability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed that the prevalence of DDH in scoliosis patients is significantly greater than that in the general population, reaching 27.5%, the findings emphasize the importance of screening and managing DDH in scoliosis patients. Additionally, the high prevalence of DDH supports the inclusion of comprehensive hip evaluations in scoliosis assessments. Future research should explore the specific pathological mechanisms underlying the association between DDH and scoliosis and assess the effectiveness of different treatment strategies for patients with both conditions. This will provide more precise guidance for clinical treatment planning.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eThis study was a retrospective study, and all the data were derived from de-identified past medical records; thus, informed consent was not needed. The research protocol was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Kunming Medical University, and a waiver of informed consent was granted (approval number: [FEY-BG-39-3.0]). All procedures performed on this study were in accordance with the ethical standards of the 1964 Helsinki declaration.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by the External Cooperation Research Project of the Second Affiliated Hospital of Kunming Medical University, Yunnan Province, China (Grant No. 2022dwhz19) and the Academician Liu Bo Workstation of Yunnan Province (Grant No. 202205AF150009).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZhou Anli and Lu Ning wrote the main manuscript text. Zhao Zhi, Li Tao, and Wang Yingsong provided the patient data materials. Cheng Jia, Sun Zhihang, and Shen Xinhe collected the data. Tang Hao and Li Wenjin performed the data analysis. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKotlarsky P, Haber R, Bialik V, Eidelman M (2015) Developmental dysplasia of the hip: What has changed in the last 20 years? World J Orthop 6(11):886\u0026ndash;901 Published 2015 Dec 18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5312/wjo.v6.i11.886\u003c/span\u003e\u003cspan address=\"10.5312/wjo.v6.i11.886\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaldonado DR, Aboulafia A, Doddridge J et al (2024) Favorable Early Outcomes and High Clinical Benefit Achievement Rate With Concomitant Hip Arthroscopy and Periacetabular Osteotomy for the Treatment of Developmental Dysplasia of the Hip. 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J Bone Joint Surg Am 61(1):112\u0026ndash;118\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Scoliosis, Developmental dysplasia of the hip, High prevalence of hip dysplasia","lastPublishedDoi":"10.21203/rs.3.rs-6088301/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6088301/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003e[Objectives]\u003c/strong\u003e: There is a complex biomechanical relationship between the spine and hip joints, but the prevalence and clinical significance of developmental dysplasia of the hip (DDH) in patients with scoliosis have not been thoroughly investigated. This study aimed to assess the prevalence of DDH in patients with scoliosis and analyze their associations with different types of scoliosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[\u003cstrong\u003eMethods]\u003c/strong\u003e: A total of 331 patients with scoliosis (average age of 16.3 years; 73% female) were included in the study. Preoperative full-length spinal radiographs were used to measure the Cobb angle, lateral center-edge angle (LCEA) and Tönnis angle. Single-sample z tests were conducted to analyze the prevalence of DDH, and the results were compared with those of the general population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[\u003cstrong\u003eResults]\u003c/strong\u003e: The overall prevalence of DDH was 27.5%, significantly higher than in the general population (1.52%). By subtype, the prevalence was 21% for idiopathic scoliosis, 39.6% for congenital scoliosis, 29.5% for neuromuscular scoliosis, and 30% for degenerative scoliosis. Among patients, 12.4% had bilateral dysplasia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[\u003cstrong\u003eConclusions]\u003c/strong\u003e: The prevalence of DDH is significantly greater in patients with scoliosis. This finding highlights the importance of systematically evaluating hip development in scoliosis patients to facilitate early intervention and improve outcomes.\u003c/p\u003e","manuscriptTitle":"High Prevalence of Hip Dysplasia in Patients with Scoliosis: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-04 14:30:12","doi":"10.21203/rs.3.rs-6088301/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e639fbf3-268d-4980-a585-da58fbce3170","owner":[],"postedDate":"March 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-29T13:23:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-04 14:30:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6088301","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6088301","identity":"rs-6088301","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}